Impact Of A Multidisciplinary Team on the Outcome of Gastroschisis

Abstract

Background: The treatment of gastroschisis (GS) patients remains controversial and challenging, with significant morbidity despite improved mortality. Multidisciplinary teams have been shown in the past to improve integration of expert management, communication with patients and families, continuity of care and patient outcome. This has not been studied for GS. Objective: To compare outcomes of GS patients managed by a multidisciplinary team (Team) versus a non-standardized approach (no Team). Design/Methods: The Canadian Pediatric Surgery Network (CAPSNet), a national surgical database, collected data on all GS patients born May 2005 to April 2009. All centers (n=16) were asked about management of GS based on the presence or absence of a Team. Bivariate analysis was performed. Outcome variables were included in a linear regression with the presence or absence of a Team as the main explanatory variable. Results: Characteristics of the patients in the 2 groups are described in Table 1. (Table presented) Patients from centers with a Team had significantly more days on parenteral nutrition (PN) and longer lengths of stay (LOS) than patients with no Team. For patients with bowel necrosis at birth, there were deaths in 9% of the Team vs 28% of the no Team group. Conclusions: GS patients in centers with Teams have significantly more PN days. The patients in both groups had comparable illness severity, however there were more deaths in the no Team group, particularly for patients with bowel necrosis at birth. This warrants further investigation.